CT-Guided Percutaneous Gastrostomy: A Tutorial

Conclusion

CT guidance is not usually required for placement of a gastrostomy tube. However, it is useful in cases with difficult access, especially those with obesity, esophageal stricture, or partial gastrectomy. With observation of key principals, percutaneous gastrostomy via CT can be a routine procedure for radiologists experienced in CT-guided procedures.

The technique of CT-guided percutaneous gastrostomy is simple, but requires attention to detail. Key points to remember are the use of lung windows for needle, guidewire, catheter, and stomach identification; maintenance of gastric distention by air insufflation; and axial CT imaging (conventional or CT-fluoroscopy) during the procedure to assure the peritoneal contents have not shifted. Puncture of the stomach is the most critical step, requiring a swift motion and the courage of conviction that the path is correct.

Gastric Puncture

Use lung windows to confirm needle tip in the gastric lumen

 

2003 by the Rector & Visitors of the University of Virginia